title: Grappling with cultural differences; communication between oncologists and immigrant cancer patients with and without interpreters.
abstract: OBJECTIVE
  Immigrants report challenges communicating with their health team. This study compared oncology consultations of immigrants with and without interpreters vs Anglo-Australian patients.
  
  
  METHODS
  Patients with newly diagnosed incurable cancer who had immigrated from Arabic, Chinese or Greek speaking countries or were Anglo-Australian, and family members, were recruited from 10 medical oncologists in 9 hospitals. Two consultations from each patient were audio-taped, transcribed, translated into English and coded.
  
  
  RESULTS
  Seventy-eight patients (47 immigrant and 31 Anglo-Australian) and 115 family members (77 immigrant and 38 Anglo Australian) participated in 141 audio-taped consultations. Doctors spoke less to immigrants with interpreters than to Anglo-Australians (1443 vs. 2246 words, p=0.0001), spent proportionally less time on cancer related issues (p=0.005) and summarising and informing (p≤0.003) and more time on other medical issues (p=0.0008) and directly advising (p=0.0008). Immigrants with interpreters gave more high intensity cues (10.4 vs 7.4). Twenty percent of cues were not interpreted. Doctors tended to delay responses to or ignore more immigrant than Anglo-Australian cues (13% vs 5%, p=0.06).
  
  
  CONCLUSIONS
  Immigrant cancer patients with interpreters experience different interactions with their doctors than Anglo-Australians, which may compromise their well-being and decisions.
  
  
  CONCLUSIONS
  Guidelines and proven training programmes are needed to improve communication with immigrant patients, particularly those with interpreters.
authors.affiliation: University of Sydney, NSW, Australia. phyllis.butow@sydney.edu.au
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.forename: Melanie
authors.initials: M
authors.lastname: Bell
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Ming
authors.initials: M
authors.lastname: Sze
authors.forename: Lynley
authors.initials: L
authors.lastname: Aldridge
authors.forename: Sarah
authors.initials: S
authors.lastname: Abdo
authors.forename: Michelle
authors.initials: M
authors.lastname: Mikhail
authors.forename: Skye
authors.initials: S
authors.lastname: Dong
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
authors.forename: Ray
authors.initials: R
authors.lastname: Ashgari
authors.forename: Rina
authors.initials: R
authors.lastname: Hui
authors.forename: Maurice
authors.initials: M
authors.lastname: Eisenbruch
mesh_terms: D000069:Acculturation; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001315:Australia; D003142:Communication; D016001:Confidence Intervals; D054521:Cultural Competency; D003469:Culture; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007802:Language; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology; D010817:Physician-Patient Relations; D013223:Statistics as Topic; D013637:Tape Recording